Professional Documents
Culture Documents
TINEA FACIALIS
By :
AULIA RAHMATUN NUFUS
RAIHANUN NISA DINUR
SRI RIZKI
Supervisor :
NANDA EARLIA
DERMATO-VENEREOLOGY
DERMATO
VENEREOLOGY DEPARTEMENT
MEDICAL FACULTY OF SYIAH KUALA UNIVERSITY
Dr. ZAINOEL ABIDIN GENERAL HOSPITAL
BANDA ACEH
JANUARY 2014
PREFACE
All praise be to Allah, the Lord of the world and peace and prayers be upon
Muhammad, his family and companions and all those who follow in their footsteps
until the last day.
In finishing this case report entitled Tinea Corporis, the authors really give they
regard and thanks to dr. Nanda Earlia, Sp. KK who has given guidance and help.
Finally, the authors realize there are unintended errors in writing this case
report. The authors really allow all readers to give their suggestion to improve this
content in order to be made as one of the good examples for the next case report.
ii
CONTENTS
Page
CONTRIBUTORS ..........................................................................................
PREFACE .........................................................................................................
ii
3. Discussion .....................................................................................................
REFERANCE ................................................................................................... 14
ATTACHMENT................................................................................................ 15
iii
INTRODUCTION
Tinea corporis is a superficial dermatophyte infection of the glabrous skin
most commonly caused by species of the genera trichophyton and mycrosporum.
When the face is affected, it is called tinea faciale whom 3%-4% of tinea corporis.
The infection as generally restricted to the stratum corneum of the epidermis. The
clinical symptoms are the result of the fungal metabolites acting as toxins and
allergens. This form of ringworm is characterized by one or more circular, sharply
cirscumscribed, slightly erithematous, dry, scaly, usually hypopigmented patches.
An advancing scalling edge is usually prominent. Progressive central clearing
procedures annular outline that give them the name ringworm. Lesions may
wider to form rings many centrimeters in diameter. In some case concentric
circles or polycyclic lesion form, making intricate patterns.1,2
The diagnosis is relatively easily made by finding the fungus under the
microscope in skin scrapings. In addition, skin scrapings can be cultured on a
suitable medium. Growth of the fungus on the culture medium is apparent within
a week or two at most and, in most instances, is identifiable to the genus level by
the gross and microscopic appearance of the culture. In this case report, patient
diagnosed tinea corporis based on history and physical examination. The patient
with complaints the appearance of rash followed by itching on the the face, upper
back, palmars and plantars since two month ago. At first, the patient found red
spots that felt very itchy on the upper back area, the rash was getting wider and
spreaded to the face, palmars and plantars area. Itching is increasing at the time of
using pads and when the groin area is moist.3,4
Dermatophyte infection are the most common skin fungal infection are age,
sex, genetics, racial factors, lifestyle, drug therapy, metabolic endocrine disorder
such as diabetes mellitus, contact with animals and environmental factors are
involved in these infection. Accordingly, accurate diagnosis, approprite treatment
of these infections health seeking behaviours and hygiene reduce their
transmission and complications. In some study, dermatophyte infection were more
prevalent in men and the moat frequent areas of involvement were the scalp, groin
and trunk. Most of them aged 20-29 years.5
1
In this case the patient has metabolic endocrine disorder skin infection
accure in 20% to 50% of diabetic patients more often in those with type 2 diabetic
and often associated with poor glicemyc control. Poor microcirculation, peripheral
vascular disease, peripheral neuropathy and decreased immune response have
been implicated in the increased susceptibility to cutaneous infection. This is our
reason to pick up tinea facialis for the case report.5
CASE REPORT
Identity of patient
Name
: Mr. R
Sex
: Male
Age
: 56 years old
Weigth
: 62 kg
Job
: Selling Vegetables
Address
Phone number
: 085277466610
Registration number
: 87-06-35
Examination date
History
The Chief Complain:
Rash followed by itching on the face, upper back, palmars and plantars since two
month ago.
History of Treatment:
Since the patient have complaint he was getting treatment from a doctor and take
medication regularly but not healed.
Status of Dermatology
Clinical Test
1. KOH examination
Procedure :
a) Place the material to be examination onto a clean glass slide
b) Add a drop of 10% KOH to the material and mix
c) Pace a cover glass over the preparation
d) Allow the KOH preparation to sit at room temperature until the material has
been cleared. The slide may be warmed to speed the clearing process. Slide
that are initially negative for fungi may be re-examined the following day.
Differential Diagnosis
1. Tinea facialis
2. Seborrheic dermatitis
3. Cutaneus candidiasis
4. Granulloma anulare
5. Morbus Hansen type pausibasiler
Resume
A 56 years old man came to the hospital complaint the appearance of rash
followed by itching on the face, upper back, palmars and plantars since two month
ago. On dermatological status was found hypopigmented patches with advancing
red, vesiculated border and central scaling and pruritic. On microscopic
examination of skin scrapings (scales) with 10% potassium hydroxide (KOH)
showed long, septate and branching hyphae and woods lamp examination did not
found fluoresce, or shine under the ultraviolet light.
6
Diagnosis
Tinea facialis
Management
Systemic Medication :
1. Ketoconazole 200 mg tab once daily for 2 to 3 weeks
Topical Medication
Education
1. Taking medicine regularly
2. Do not scratch the rash to prevent the secondary infection
3. Change clothes when the body is sweating
4. Wearing loose clothing and materials that easily absorb sweat
5. Dry off after a shower and sweating
Prognosis
Quo ad vitam
: dubia ad bonam
Quo ad functionam
: dubia ad bonam
DISCUSSION
Tinea corporis
(ringworm)
Tinea
pedis
(athlete`s foot)
Tinea
cruris
(jork itch)
Tinea capitis
Tinea barbae
Tinea Unguium
(onychomycosi)
Dermatophytid
(id reaction)
Location of
lesions
Clinical Features
Fungi Most
Frequently
Responsible
Nonhairy, smooth Circular patches with advancing T.
rubrum,
skin.
red, vesiculated border and central E.floccosum
scaling. Pruritic.
Interdigitalis
Acute: itching, red vesicular. T. rubrum, T.
spaces on feet of Chroni: itching, scaling, fissures
mentagrophytes,
persons wearing
E.floccosum
shoes.
Groin.
Eritematous scaling lesion in T. rubrum, T.
intertridiginous area. Pruritic.
mentagrophytes,
E.floccosum
Scalp
hair. Circular bald patches with short T.
Endothrix: fungus hair stubs or broken hair within mentagrophytes,
inside hair shaft. hair
follicles.
Kerion
rare. M.canis
Ectothrix: fungus Microsporum-infected
hairs
on surface of hair. fluoresce.
Beard hair.
Edematous, erythematous lesion.
T.
mentagrophytes
Nail.
Nails thickened or crumbling T. rubrum, T.
distally;discolored;lusterless.
mentagrophytes,
Usually associated with tinea E.floccosum
pedis.
Usually sides and Pruritic vesicular to bullous No fungi present
flexor
aspects lesions.
Most
commonly in lesion. May
fingers.
Palm. associated with tinea pedis.
become
Anysite on body.
secondarily
infected
with
bacteria.
10
predilection are face, ears, scalp, and upper part of the trunk. The affected skin is
pink, edematous, and covered with yellow-brown scales and crusts. In all patient
with seborrheic dermatitis is called seborrheic stage, whice is often combined
with a grey white or yellow res skin discoloration, prominent follicular openings
and mild to severe pityriasiform scales. Several form can be distinguished.6
Cutaneous candidiasis has a predilection for colonizing moist, macerated
folds of skin. Intertrigo is the most common clinical presentation on glabrous skin.
Usual locations for intertrigo include the genitocrural, axilary, gluteal, interdigital,
and inframammary areas and between folds of skin on the abdominal wall.
Cutaneous candidiasis appears as pruritic, erytematous, macerated skin in
intertriginous areas with satellite vesicopustules. These pustules break open,
leaving an erythematous base with collarette of easily detachable necrotic
epidermis. Cutaneous candidiasis diagnosed by the typical appearance of skin
lesions and the presence of satellite vesicopustules. Of all the clinical symptoms
found such lesions form.6
Based on the shape of lesion Granuloma annulare starts as a ring of small,
firm, flesh-colored or red papules. As the condition progresses, there is some
central involution, and the ring of papules slowly increases from 0.5 to 5.0 cm in
diameter. The lesions may be isolated or coalesce into plaques. They are found on
the lateral or dorsal surfaces of the hands and feet. Tinea facialis have different
form of lesions so differential diagnose can be removed .3
Morbus Hansen is painless skin patch accompanied by loss of sensation but
not itchiness.6
Therapy in this case are oral ketoconazole 200 mg once daily for 2 to 3
weeks and ketoconazole 2% cream applied once daily at night for 2 to 4 weeks
and miconazole cream once daily in the morning for 2 to 4 weeks. This is
accordance with literature that systemic antifungal therapy is indicated if the
lesions are extensive or fails to topical treatment, recurrent or chronic, or if the
skin condition gets worse. Ketoconazole and miconazole is an antifungal azole
class, broad-spectrum imidazole group, fungistatic and can be given to patients
who do not respond to topical therapy. Mechanism of action of this drug to inhibit
ergosterol
biosynthesis
enzyme
cytochrome
P-450,
C-14--dimethylase
11
Topical Treatment
Tinea capitis
Only as adjuvant
Selenium sulfide
Zinc pyrithione
Povidone iodine
Ketokenazole
Only as adjuvant
Topical antifungal
Tinea barbae
Tinea
corporis/kruris
Allylamines
Imidazoles
Tolnaffate
Butenafine
Ciclopirox
Tinea
manum
Allylamine
Azole
Ciclopirox
Benzylamine
Tolnaftate
Undecenoic acid
Ciclopirox
Amorolfine
pedis/
Onychomycosis
Systemic Treatment
Griseofulvin, 20-25 mg/kg/day
Fluconazole,6 mg/kg/day
Itraconazole,3-5 mg/kg/day
Terbinafine,3-6 mg/kg/day
Griseofulvin 1g/day
Itraconazole 200 mg/day
Terbinafine 250 mg/day
Fluconazole 200 mg/day
Adults:
Fluconazol 150 mg/week
Itraconazole 100 mg/day
Terbinafin 250 mg/day
Griseovulvin 500 mg/day
Children:
Griseovulvin 10-20 mg/kg/day
Itraconazole 5 mg/kg/day
Terbinafrin 3-6 mg/kg/day
Adults:
Terbinafine 250 mg/day
Itraconazole 200 mg twice/day
Fluconazole 150 mg/week
Children:
Itraconazole 5 mg/kg/day
Terbinafine 250 mg/day
Itraconazole 200 mg/day
Fluconazole 150-300 mg once/week
12
Based literature for systemic treatment, the imidazole preparations have the
advantage of being broad have the adventage of being broad spectrum antibiotic
and effective againts candida spp. and some case, bacteria. In vitro ketoconazole
and the azoles in general have about the same susceptibility pattern as
griseofulvin. Infections that failed to respond to griseofulvin treatment have
sometimes responded to ketoconazole. Actual development of griseofulvin
resistance has been noted in some dermatophytes.2
Non medicamentosa management and prevention of relapse of disease is
very important, such as reducing the predisposing factors, namely temperature,
humidity and occlusion by advocating wearing loose clothing and materials that
easily absorb sweat, dry off after a shower and sweating, and washing the clothes
that contaminated.9,10
The prognosis in normal patients tinea facialis resolves spontaneously after
a few months. The less tendency toward chronicity than in tinea pedis and tinea
cruris. The treatment aids in the resolution of lesion and effects a clinical cure.
Reinfection of the same area may occur within a few weeks to months if the
patient is again exposed to infectious material. In some patients lesions of tinea
facialis reappear at regular interval.2
13
REFERENCE
1.
James WD, Berger TG, Elston DM. Disease Resulting From Fungi and
Yeasts In Andreaw`s Disease of the skin clinical Dermatology. 10
th
ed.
3.
4.
5.
of
Dermatophyte
Infections
in
Southwest
iran.
Acta
7.
8.
9.
10.
14
ATTACHMENT
Table 3. Several things which found and the relationship with some theory
Case
Literature
Anamnesis
Status of
On facial and
palmars dextra
and sinistra
region, found
erythematous
patches and
hypopigmentation
with
circumpscripta
boundary,
irregular and
polycyclic edges,
Patient diagnosed
tinea fasialis based
on history and
physical
examination. The
patient with
complaints the
appearance of rash
followed by
itching on the the
face, upper back,
palmars and
plantars since two
month ago. At
first, the patient
found red spots
that felt very itchy
on the upper back
area, the rash was
getting wider and
spreaded to the
face, palmars and
plantars area.
Itching is
increasing at the
time of using pads
and when the
groin area is
moist.
This form is
characterized by
one or more
circular, sharply
cirscumscribed,
slightly
erithematous, dry,
scaly, usually
hypopigmented
patches. An
advancing scalling
edge is usually
dermatology
Author
There are
similarities
between the case
and the theory
which states that
tinea facialis
symptom.
There are
similarities
between the case
and the theory
which states that
tinea facialis
description.
15
Clinical test
Microscopic
examination of
skin scrapings
(scales) with 10%
potassium
hydroxide (KOH)
showed long,
septate and
branching hyphae.
Therapy
Therapy in this
case are oral
ketoconazole 200
mg once daily for
2 to 3 weeks and
ketoconazole 2%
cream applied
once at night for 2
to 4 weeks and
than miconazole
cream once daily
in the morning.
prominent.
Progressive
central clearing
procedures
annular outline
that give them the
name ringworm.
Lesions may
wider to form
rings many
centrimeters in
diameter. In some
case concentric
circles or
polycyclic lesion
form, making
intricate patterns.
Direct
microscopic
examination of
skin scrapings
specimens using
10 % KOH will
show septate
hyphae and
squared or
rounded,
irregularly
arranged
arthroconidia.
Ketoconazole and
miconazole is an
antifungal azole
class, broadspectrum
imidazole group,
fungistatic and can
be given to
patients who do
not respond to
topical therapy.
There are
similarities
between the case
and the theory
which states that
tinea facialis
description.
There are
similarities
between the case
and the theory
which states that
tinea facialis
treatment.
16
Seborrheic
dermatitic
17
Cutaneous
candidiasis
Granulloma
anulare
a predilection for
colonizing moist,
macerated folds of
skin. Intertrigo is the
most common
clinical presentation
on glabrous skin.
Usual locations for
intertrigo include the
genitocrural, axilary,
gluteal, interdigital,
and inframammary
areas and between
folds of skin on the
abdominal wall.
Cutaneous
candidiasis appears
as pruritic,
erytematous,
macerated skin in
intertriginous areas
with satellite
vesicopustules.
Based on the shape of
lesion Granuloma
annulare starts as a
ring of small, firm,
flesh-colored or red
papules. As the
condition progresses,
there is some central
involution, and the
ring of papules
slowly increases from
0.5 to 5.0 cm in
diameter. The lesions
may be isolated or
coalesce into plaques.
They are found on
the lateral or dorsal
surfaces of the hands
and feet.
18
Morbus Hansen
19